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GIR Test 3 > B5-030 CBCL: Viral Hepatitis > Flashcards

B5-030 CBCL: Viral Hepatitis Flashcards

1
Q

ssRNA picorna virus

A

HAV

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2
Q

dsDNA hepadenovirus

A

HBV

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3
Q

ssRNA flavivirus

A

HCV

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4
Q

circular defective ssRNA deltavirus

A

HDV

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5
Q

ssRNA hepevirus

A

HEV

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6
Q

what hepatitis viruses have a vaccine available?

A

A and B

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7
Q

what hepatitis viruses are spread fecal-orally?

A

A and E

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8
Q

what serology is used to diagnose Hep A?

A

IgM

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9
Q

what serology is used to diagnose Hep B?

A

HBsAg
HBcAg
PCR

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10
Q

what serology is used to diagnose Hep C?

A

HCAb
PCR

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11
Q

what serology is used to diagnose Hep D?

A

HDV IgM
PCR

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12
Q

what serology is used to diagnose Hep E?

A

HEV PCR, IgM

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13
Q

which hepatitis viruses cause acute infection?

A

A and E

AcutE

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14
Q

what will be the biggest clinical distinguishing factor between Hepatitis A and E?

A

exposure risk

A: daycares
E: travel, unclean water, shellfish, etc.

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15
Q

elevated liver transaminases into the 1000s indicates

A

Hep A/E

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16
Q

fulminant hepatic failure occurs in 20% of pregnancy cases

A

Hep E

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17
Q

whats a good way to differentiate the acute hepatic viruses causing hepatitis from CMV, EBV, etc.?

its a lab value

A

CMV/EBV usually only cause liver transaminases to rise into the 100s and usually have associated pharyngitis

HepA/E would cause AST/ALT into the 1000s

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18
Q

first stage of liver scarring after portal tract inflammation

A

fibrosis

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19
Q

HCV induces insulin resistance leading to […] which contributes to fibrosis

A

steatosis

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20
Q

when fibrosis takes over the whole liver, fibrous tissue encompases regenerating nodules causing a nodular appearance

A

cirrhosis

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21
Q

associated with aplastic anemia, glomerulonephritis, polyarteritis nodosa

A

Hep B

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22
Q

associated with metabolic disorders, cryoglobulinemia, glomerulonephritis

A

Hep C

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23
Q

combination therapies for Hep C

2

A
  • glecaprevir/pibrentasvir
  • sofosbuvir/velpatasvir

other based on genotype

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24
Q

first line treatment for Hep B

A

tenofovir, entecavir

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25
Q

who should be treated for Hep B?

A
  • pregnant
  • active malignancy
  • HIV
  • immunosuppressed
  • liver failure related to Hep B
  • very high viral load
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26
Q

what is the mechanism of action for tenofovir, entecavir, and adefovir

A

reverse transcriptase inhibitor

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27
Q

what two antivirals are not preferred for Hep B due to increasing resistance?

A

adefovir
lamivudine (cystosine analog)

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28
Q

who should be treated for Hep C?

A

everyone with HCV except those with short life expectancy due to liver failure

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29
Q

MOA for NS5A inhibitors

-asvir

A

inhibit NS5A which aids in RNA replication

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30
Q

side effects of NS5A inhibitors?

-asvir

A

headaches
diarrhea

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31
Q

MOA of NS5B inhibitors?

-buvir

A

inhibit NS5B, RNA-dependent polymerase that acts as a chain terminator

prevents RNA replication

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32
Q

side effects of NS5B inhibitors?

-buvir

A

headache
fatigue

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33
Q

MOA for NS3/4A inhibitors

-previr

A

inhibit NS3/4A protease preventing viral replication

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34
Q

side effects of grazoprevir

NS3/4A inhibitor

A

headache
fatigue

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35
Q

side effects of simeprevir

NS3/4A inhibitor

A

photosensitvity
rash

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36
Q

inhibits synthesis of gaunine nucelotides by competing with IMP dehydrogenase

A

ribavirin

37
Q

side effects of ribavirin

A

anemia
fatigue
rash

38
Q

if a patient has Hep C and diabetes, monitor for

A

hypoglycemia

39
Q

if a patient has hep C and cirrhosis, monitor for

2

A

HCC
varices

40
Q

treatment for Hep A?

A

supportive

41
Q

which hepatic virus causes steatohepatitis?

A

hep C

42
Q

the presence of […] indicates the hepatitis B vaccine has been effective

A

anti-HBs

43
Q

treatment for hep B?

3

A
  • highly concentrated Hep B IgG
  • INF-a
  • nucleotide analogs that inhibit viral replication
44
Q

nucleotide analogs that inhibit viral replication

4

A
  • adefovir
  • telbivudine
  • entecavir
  • tenofovir
45
Q

which hepatic viruses cause chronic infection?

A

B, C, D

46
Q

what is the best test to determin active Hep B infection?

A

HBsAg detection

47
Q

associated with a high mortality rate in pregnant women

A

Hep E

48
Q

what is the most important goal of treatment in chronic HBV infection?

A

lose HBsAg from serum

49
Q

is HCV IgG protective against reinfection?

A

no

replicates/changes to evade immune system

50
Q

daycares are associated with an increased risk of

A

HAV

51
Q

HAV IG is effective at preventing HAV in unvaccinated, exposed individuals if given within

A

2 weeks

52
Q

ribavirin is used to treat

A

HCV

53
Q

in the case of an HAV outbreak, what next step should be taken by the health department?

A

administer IG to all previously unvaccinated exposed individuals

can give vaccine at same time

54
Q

if it is not feasible for a patient to receive both vaccines in the Hep A series prior to traveling to an endemic area, what is the best recommendation?

A

first dose 4 weeks before + IG

55
Q

how is the hep A vaccine administered?

A

two shots 6-12 months apart

56
Q

what serum markers would be elevated in the acute phase of an HBV infection?

A

HBeAg and HBsAg

57
Q

approximately […] of needle sticks result in HCV infection

%

A

5%

58
Q

[…] % of HCV infections become chronic

A

70-80

59
Q

major risk factor for development of cirrhosis in HCV infected patients

A

alcohol

60
Q

normal alpha fetoprotein

A

less than 20

61
Q

what laboratory test is useful for determining HCC?

A

a-fetoprotein

62
Q

Anti-HBsAg +
Anti-HBcAg +
Anti-HBeAg+

A

previous HBV infection, now recovered

63
Q

HBV in neonates and young children results in chronic infections […]% of the time

A

90

64
Q

large cytoplasmic inclusions that push the nucleaus to one side of the cell

A

ground glass hepatocytes (HBV)

65
Q

considerations for treatment in HBV

A
  • over 40 years of age
  • family hx of liver cancer
  • extrahepatic complications (vasculitis, renal disease)
66
Q

nucleosides analogues that share cross-resistance

A

telbivudine
lamivudine

67
Q

the major drawback of INF-a therapy

A

flu-like side effects

68
Q

what medication can cause the rare side effect of renal insufficiency?

A

tenofovir disproxil fumarate

69
Q

should the same dose of entecavir be used for treatment-naive patients and lamivudine-resistant patients?

A

no, lamivudine resistant patients should receive a larger dose

70
Q

how quickly after exposure should HBV ppx be administered?

A

ideally within 24 hours
benefit shown up to 7 days

71
Q

post-exposure PPX for HBV should include

2

A

first dose of vaccine and HBIG

72
Q

[..]% of healthcare workers have not completed the HBV series

A

25

73
Q

without post-exposure ppx, what is the risk of contracting HBV from a needle stick?

%

A

5%

74
Q

all pregnant women should be screened for HBV by screening serum for

A

HBsAg

prevents perinatal HBV transmission

75
Q

preferred screening test to determine whether the mother is at risk of transmitting HBV to her child

A

HBsAg

76
Q

a normal ALT does not exclude […] in HBV-HIV coinfected patients

A

possibility of fibrosis

77
Q

INF-a should be used with caution in patients with

A

cirrhosis

increases risk of immune-modulated hepatic decompensation

78
Q

has combination therapy with two or three antivirals been shown to improve outcomes over single therapy in patients with chronic HBV?

A

no

79
Q

Anti-HCV positive indicates

A

HCV infection

80
Q

does HCV have a vaccine?

A

no

81
Q

has recently been reported to be transmitted zoonotically, through organ transplantation, or blood transfusions

A

HEV

82
Q

occurs when Hep B is present and constant usage of alcohol damages the liver

A

Hep D

83
Q

edema, weight gain, and ascites are signs of

A

cirrhosis

84
Q

anti-HBs IgG+ likely indicates

A

vaccination against hep B

85
Q

associated with recent travel history

A

Hep A

86
Q

laboratory indicators of hepatitis

2

A
  • elevated transaminases
  • elevated serum bilirubin
87
Q

recommended treatment for exposure to HBV in unvaccinated individuals

A

HBIG + HBV vaccine

88
Q

treatment for acute hepatitis

A

adequate nutrition and rest

GIR Test 3 (16 decks)

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